Exporting and Negotiating Human Rights

In 2000, renowned Egyptian activist-sociologist Saad Eddin Ibrahim and 27 colleagues were tried, convicted and imprisoned by the Egyptian government on a range of politically-motivated charges. In 2003, Ibrahim was released after three years of imprisonment and torture and a concerted campaign to secure his release by concerned academics, activists, and political leaders. Two years later, physically weakened but morally indefagitable, he visited colleagues at the University of Colorado and talked about his experiences as an academic and activist

Global Health and Global Hegemony

As the new director of a unique graduate program in Global Health Affairs, coming from the world of basic research, I have been faced with the need to reconcile a central paradox of American power and hegemony: I conduct my work as an American citizen and often with U.S. government funding in the hope that it will make a positive or at least neutral impact on my world. Yet my government (not only under the present administration) initiates imperial adventures that cause untold damage to the health, welfare, and survival of individuals throughout the world

Homelessness and Public Health in Los Angeles

Los Angeles faces a housing crisis of unprecedented scale. After years of underinvestment, in 2016/2017 LA County voters approved Measures H and HHH, which provided an infusion of resources for homeless services, permanent housing, and integrated outreach through the LA County Homeless Initiative (HI). An estimated 58,936 individuals in LA County remain homeless as of January 2019, 75% of them unsheltered and living on streets, in tents, or encampments. Our best estimates suggest that the homeless population has grown since 2017.HI takes a Housing First approach to homelessness, with the largest amount of total funds allocated to housing solutions. However, rehousing is often subject to delays in construction and case management. These delays, combined with persistent market forces driving new homelessness, have left the county well short of its targets. While no forecasts were issued, the initial gap analysis for HI had assumed a 34% reduction in the total homeless count from 2016 to 2019. The count has in fact increased by 26% over that period, meaning 28,000 more homeless clients than anticipated on any night. Whereas cities with comparable homeless crises such as New York have focused on increasing the availability of emergency shelters and safe havens in addition to permanent housing, LA County’s relatively low investment in transitional options has resulted in persistent levels of unsheltered homelessness.Research has shown that homelessness has severe health consequences. Homeless individuals have a high risk of mortality, with a recent LA County Medical Examiner report finding an average age of death of 48 for women and 51 for men. Homeless individuals have much higher risks of mental illness, substance abuse, infectious disease, chronic illness, violence, and reproductive health risks than the general population. Much less is known about the health burdens associated with being unsheltered, but most evidence points to substantially greater health risks given the more intense exposures to violence, weather, pollution, poor sanitation, and behavioral risk. Research is just beginning to quantify the burdens of living on the streets.Our analysis of the LA County homelessness response drew on expert interviews, data analysis, and document review. Beyond the growing numerical gap between HI’s targets and actual trends, we identified five critical service gaps that require immediate attention: Taking a person-centered approach that recognizes both the diversity of client needs and the limitations of existing resources, yet honors the principle that everyone deserves housing; Improving access to emergency shelters by reducing legal and political barriers to construction and adopting “low barrier shelters” that facilitate entry; Delivering comprehensive street medicine and other services to unsheltered homeless populations using evidence-based models that support the path to housing and recovery Adopting more extensive outreach models that engage citizens, empower homeless clients and leverage mobile technology so that case workers can focus on clients most in need; Strengthening data collection and research methods to understand the consequences of unsheltered homelessness, pilot new service models, and evaluate rehousing efforts

Estimated Emergency and Observational/Quarantine Capacity Need for the US Homeless Population Related to COVID-19 Exposure by County; Projected Hospitalizations, Intensive Care Units and Mortality

This report estimates the potential hospitalization, ICU use and mortality rates associated with COVID-19 infection among the homeless population in the United States, as well as unmet need for emergency and observational/quarantine beds/units. Results project that homeless individuals infected by COVID-19 would be twice as likely to be hospitalized, two to four times as likely to require critical care, and two to three times as likely to die than the general population. The analysis suggests that 400,000 new beds are needed to meet the emergency accommodation and social distancing needs of the single adult homeless population on a given day, and that the total estimated cost to meet the nation’s emergency shelter and observational/quarantine units need is approximately $11.5 billion for one year. The second edition explores alternatives for emergency accommodation including private accommodations, congregate shelters, sheltering in place, and emergency coordination of care.

Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data

This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988-1995) and Philadelphia (1991-1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to over-represent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs

Predictors of Exit and Reentry among Family Shelter Users in New York City

This study explores the process of exit from and reentry to public family shelters for homeless families in New York City. A Cox proportional-hazards model was developed to identify the effects of demographic, family structure, reason for homelessness, an time-related variables on the hazard rates for different types of shelter discharge and shelter reentry. The study specifically explores the significance of type of housing placement as a predictor variable for shelter reentry. Various demographic and family structure attributes are linked with shelter exit and reentry, including race and ethnicity, family size, age of family head, pregnancy status, and public assistance recipiency status. Although there is a trade-off between length of shelter stay and type of housing placement at shelter discharge, procuring subsidized housing is associated with a substantially lower probability of shelter readmission. Policy implications of these findings and future directions for research on the dynamics of family homelessness are discussed

Stellar Double Coronagraph: a multistage coronagraphic platform at Palomar observatory

We present a new instrument, the "Stellar Double Coronagraph" (SDC), a flexible coronagraphic platform. Designed for Palomar Observatory's 200" Hale telescope, its two focal and pupil planes allow for a number of different observing configurations, including multiple vortex coronagraphs in series for improved contrast at small angles. We describe the motivation, design, observing modes, wavefront control approaches, data reduction pipeline, and early science results. We also discuss future directions for the instrument.Comment: 25 pages, 12 figures. Correspondence welcome. The published work is open access and differs trivially from the version posted here. The published version may be found at http://iopscience.iop.org/article/10.1088/1538-3873/128/965/075003/met

The Co-Occurrence of AIDS and Homelessness: Results from the Integration of Administrative Data for AIDS Surveillance and Public Shelter Utilization in Philadelphia

STUDY OBJECTIVE: Administrative databases from the City of Philadelphia that track public shelter utilisation (n=44 337) and AIDS case reporting (n=7749) were merged to identify rates and risk factors for co-occurring homelessness and AIDS. DESIGN: Multiple decrement life tables analyses were conducted, and logistic regression analyses used to identify risk factors associated with AIDS among the homeless, and homelessness among people with AIDS. SETTING: City of Philadelphia, Pennsylvania, USA. MAIN RESULTS: People admitted to public shelters had a three year rate of subsequent AIDS diagnosis of 1.8 per 100 person years; nine times the rate for the general population of Philadelphia. Logistic regression results show that substance abuse history (OR = 3.14), male gender (OR = 2.05), and a history of serious mental disorder (OR = 1.62) were significantly related to the risk for AIDS diagnosis among shelter users. Among people with AIDS, results show a three year rate of subsequent shelter admission of 6.9 per 100 person years, and a three year rate of prior shelter admission of 9%, three times the three year rate of shelter admission for the general population. Logistic regression results show that intravenous drug user history (OR = 3.14); no private insurance (OR = 2.93); black race (OR = 2.82); pulmonary or extra-pulmonary TB (OR = 1.43); and pneumocystis pneumonia (OR = 0.56) were all related to the risk for shelter admission. CONCLUSIONS: Homelessness prevention programmes should target people with HIV risk factors, and HIV prevention programmes should be targeted to homeless persons, as these populations have significant intersection. Reasons and implications for this intersection are discussed

Evidence-Based Pediatric Outcome Predictors to Guide the Allocation of Critical Care Resources in a Mass Casualty Event

Objective: ICU resources may be overwhelmed by a mass casualty event, triggering a conversion to Crisis Standards of Care in which critical care support is diverted away from patients least likely to benefit, with the goal of improving population survival. We aimed to devise a Crisis Standards of Care triage allocation scheme specifically for children. Design: A triage scheme is proposed in which patients would be divided into those requiring mechanical ventilation at PICU presentation and those not, and then each group would be evaluated for probability of death and for predicted duration of resource consumption, specifically, duration of PICU length of stay and mechanical ventilation. Children will be excluded from PICU admission if their mortality or resource utilization is predicted to exceed predetermined levels (“high risk”), or if they have a low likelihood of requiring ICU support (“low risk”). Children entered into the Virtual PICU Performance Systems database were employed to develop prediction equations to assign children to the exclusion categories using logistic and linear regression. Machine Learning provided an alternative strategy to develop a triage scheme independent from this process. Setting: One hundred ten American PICUs Subjects: One hundred fifty thousand records from the Virtual PICU database. Interventions: None. Measurements and Main Results: The prediction equations for probability of death had an area under the receiver operating characteristic curve more than 0.87. The prediction equation for belonging to the low-risk category had lower discrimination. R2 for the prediction equations for PICU length of stay and days of mechanical ventilation ranged from 0.10 to 0.18. Machine learning recommended initially dividing children into those mechanically ventilated versus those not and had strong predictive power for mortality, thus independently verifying the triage sequence and broadly verifying the algorithm. Conclusion: An evidence-based predictive tool for children is presented to guide resource allocation during Crisis Standards of Care, potentially improving population outcomes by selecting patients likely to benefit from short-duration ICU interventions. (Pediatr Crit Care Med 2015; XX:00–00) Key Words: intensive care unit length of stay; intensive care unit mortality; mass casualty; palliative care; pandemic preparedness; triag